Study On Correlation Between Cumulative Exposure Value Of Metabolic Factors And The Progression And Restenosis After Interventional Therapy Of Lower Extremity Arterial Disease

Backgrounds and objective:Lower extremity arterial disease(LEAD),resulting from a partial or complete obstruction of one or more arteries of lower limb,is a local manifestation of systemic arteriosclerosis in the lower limb.It is worth noting that LEAD has been found to be 4 times more frequent in subjects with type 2 diabetes mellitus(T2DM)compared to the non-diabetic subjects,and the poor prognosis of LEAD is parallel to the severity of diabetes.In addition to the factors associated with race,poverty and industrialization,the development of LEAD is also closely related to cardiovascular risk factors.However,the study on the impact of long-term dynamic changes in metabolic factors on disease progression is of great significance for further intervention in related factors to delay disease progressionThe available treatment of LEAD includes medical pharmacotherapy,endovascular revascularization,and surgical intervention.With the rapid development of intervention technique,endovascular intervention has been widely used in the treatment of symptomatic lower limb arteriosclerosis occlusion disease or ischemic ulcer owing to its micro-invasiveness and marked effect.Endovascular intervention plays an important role in the treatment of LEAD in T2 DM,but the incidence of in-stent restenosis(ISR)is still high.Therefore,take active steps to seek and manage residual risk factors which affect restenosis is of great significance for the prognosis,reduction of amputation rate,reduction of cardiovascular adverse events,and improvement of life quality in LEAD patients after interventional surgery.Most of the existing studies have analyzed the impact of baseline metabolic values on the development of disease or postoperative recovery.However,the measurement of single metabolic indicators is not enough to represent the individual metabolic level over a long period of time,which has certain limitations.Cumulative exposure value,a measure of the severity and duration of study indicator exposure,is often used to assess the relationship of study indicators with disease risk and correlation with disease progression,with greater value for further predicting the development of disease.The above studies suggest that cumulative exposure values may have a better predictive effect on the occurrence and development of diseases,but there is still lack of research to explore the relationship between cumulative exposure values and the progression or restenosis after treatment of LEAD.Therefore,the purpose of this study is to explore the related risk factors for the progression of LEAD and the restenosis after interventional therapy by analyzing the cumulative exposure metabolic value.Moreover,this study is benefial for clinical doctors to strengthen the management of risk factors related to LEAD and improve the long-term patency rate after interventional surgery.Objects and Methods:Part Ⅰ: Study on correlation between cumulative exposure to metabolic factors and progression of lower extremity arterial disease in type 2 diabetic patients.T2DM patients with LEAD who had completed clinical data and follow-up data for three consecutive years,were recruited from Department of Hypertension and Endocrinology,Daping Hospital,Army Military Medical University,from January 2013 to March 2021.The general clinical data and biochemical parameters were collected.Part Ⅱ: Study on correlation between cumulative metabolic factors and restenosis after interventional therapy for lower extremity arterial diseaseThe general data and biochemical parameters of 110 patients with arterial occlusive symptoms of low limbs who admitted to the Department of Hypertension and Endocrinology,Daping Hospital,Army Military Medical University from January 2007 to July 2021 were collected.All patients underwent endovascular intervention,and regular follow-up.Results:Part Ⅰ: Study on correlation between cumulative exposure to metabolic factors and progression of lower extremity arterial disease in type 2 diabetic patients.1.Totally 157 type 2 diabetic patients were enrolled,and 63 patients had LEAD progression.Compared with LEAD non-progression group,the LEAD progression group had older age,longer history of diabetes and hypertension,higher usages of medications,including lipid regulating and anti-platelet drugs.2.In the LEAD progression patients,the baseline,terminal,and cumulative ABI were lower,while the baseline systolic blood pressure(SBP)and diastolic blood pressure(DBP)were higher.(P<0.05).Compared with the LEAD non-progression group,patients in LEAD progression group had higher cumulative exposure values of SBP,DBP,total cholesterol(TC),fasting plasma glucose(FPG),Glycosylated Hemoglobin angiography(Hb Alc),hypersensitive C-reactive protein(hs-CRP),microalbumin(MALB)and urinary albumin creatine ratio(UACR)(P<0.05).3.Multivariate Cox regression analysis indicated that diabetic cerebrovascular diseases,peripheral neuropathy,cumulative exposure value of SBP and that of UACR were independent risk factors for LEAD progression.Part Ⅱ: Study on correlation between cumulative metabolic factors and restenosis after interventional therapy for lower extremity arterial disease1.Compared with non-restenosis group,the percentage of patients with smoking and TASC type II C or D femoropopliteal artery lesions(here after referred to as TASC type II)were higher in restenosis group.But the percentage of patients with regular postoperative use of antiplatelet agents and preoperative ABI were significantly lower than those in non-restenosis group.2.Compared with non-restenosis group,patients in restenosis group had higher baseline,6-month,1-year,and 2-year follow-up hs-CRP,meanwhile the cumulative exposure values of hs-CRP,triglyceride,low-density lipoprotein cholesterol were significantly higher.3.Binary logistic regression analysis showed that smoking,TASC II typing,cumulative exposure value of hs-CRP,that of LDL-C,and that of TG were the risk factors for restenosis2 years after surgery,and regular postoperative use of antiplatelet drugs was a protective factor.Conclusions:1.Increased cumulative exposure values of SBP and UACR,diabetic cerebrovascular disease,and peripheral neuropathy are independent risk factors for progresion of LEAD in T2 DM patients.2.Smoking,TASC Ⅱ typing,and cumulative expore values of hs-CRP,LDL-C,and TG were the risk factors for restenosis of blood vessels after intervention in patients with lower extremity atherosclerotic occlusive disease.The regular use of postoperative antiplatelet drugs was a protective factor.This study suggests that continuous smoking cessation,enhanced lipid-lowering,reduced residual risk of blood lipids,and anti-inflammatory measures are key factors in reducing the incidence of postoperative vascular restenosis.Early intervention in vascular lesions has a better long-term effect than severe lesions.